Provider Demographics
NPI:1093937591
Name:SAN DIEGO FREEDOM RANCH, INC.
Entity Type:Organization
Organization Name:SAN DIEGO FREEDOM RANCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUFFAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II, ICADC
Authorized Official - Phone:619-478-5696
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906
Mailing Address - Country:US
Mailing Address - Phone:619-478-5696
Mailing Address - Fax:619-478-2404
Practice Address - Street 1:1777 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906
Practice Address - Country:US
Practice Address - Phone:619-478-5696
Practice Address - Fax:619-478-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370004AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility